USMLE Question of the Week

Evaluating Abdominal Pain During Pregnancy

In Episode 60 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question: A 26-year-old primigravid woman at 34 weeks’ gestation presents to the emergency department with 6 hours of worsening, severe right flank pain, nausea, vomiting, malaise, and chills. She reports good fetal movement and mild intermittent uterine contractions. She denies vaginal bleeding or leakage of fluid. Temperature is 38.2 C, heart rate is 118/min, respiratory rate is 20/min, and blood pressure is 94/65. On examination she has diffuse abdominal tenderness, worse in the right mid-abdomen, without rebound, guarding, or costovertebral angle tenderness. Pelvic examination reveals a closed cervix. Laboratory studies reveal a serum leukocyte count of 17,400 with a left shift. Microscopic examination of a clean catch urine specimen shows 4-5 leukocytes and positive leukocyte esterase, and no nitrites or bacteria. Fetal heart tracing is reactive with moderate variability and a rate of 165/min. Which of the following is the most likely diagnosis?
  • Cholecystitis
  • Chorioamnionitis
  • Pelvic inflammatory disease
  • Pyelonephritis
  • Appendicitis
  • Hepatitis
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Faustine Ramirez

Faustine graduated from the University of Washington in Seattle with a B.A. in Medical Anthropology and Global Health. She attends medical school at University of California, San Francisco where she designed and taught a course on clinical reasoning skills, developed curriculum materials for the pre-clinical pediatrics course, and led case-based sessions in pediatrics and infectious disease. She received a 253 on Step 1 and a 266 on Step 2 CK, and she scored in the 90th percentiles on all of her shelf exams.

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